Acute Myocardial Infarction

Question 1

What is chronic stable angina?

Answer 1

When there is fexied stenosis of the coronary artery whcih leads to demand led ischaemia.

Question 2

Angina can radiate through to arms and up to jaw. True or False?

Answer 2

True, it has the possibility of radiation.

Question 3

What is acute coronary syndome and what is included in it?

Answer 3

Any acute presentation of coronary artery disease.
It includes:
Unstable angina
Acute NSTEMI
STEMI

Question 4

Acute MIs can come in 2 forms, what are they?

Answer 4

ST elevation MI

Non ST elevation MI.

Question 5

What are the causes for acute coronary syndromes?

Answer 5

They are on a spectrum from the build up of an atherosclerotic plaque. When the plaque ruptures, a thrombus can form and at this moment this is when acute coornary syndomes can occur.

Question 6

Acute coronary syndromes are unstable and safe. True or False?

Answer 6

Partially true, they are unstable, HOWEVER they are dangerous, due to the unpredictability.

Question 7

What is the main cause of occlusion of an artery to cause acute coronary syndrome?

Answer 7

The plaque rupturing and a thrombus forming due to the coagulation cascade.

Question 8

How would an MI present?

Answer 8

Severe crushing central chest pain
Radiation to jaw and arms (particularly left)
Similar to angina, more severe and not relieved by GTN.
Associated with sweating, nausea and vomiting.

Question 9

What the main differences between angina and an MI?

Answer 9

Angina is a much shorter period of time and occurs on exertion not at rest like an MI.

Question 10

How would you diagnose an MI and what would you look for?

Answer 10

ECG:
ST elevation
T wave inversion
Q waves.

Question 11

What classifies as a STEMI?

Answer 11

> /=1mm ST elevation in 2 adjacent limb leads
/=2mm ST elevation in at least 2 continuous precordial leads
New onset bundle branch block.

Question 12

What are the evolving ECG changes of an acute MI during and after an MI?

Answer 12

First few hrs- ST elevation
First day- Q wave formation and T wave inversion
‘Old’ MI- Q waves and inverted T waves.

Question 13

What is the anatomical site of an MI is there is ST elevation in leads II, III and aVF?

Answer 13

Inferior MI

Question 14

What is the anatomical site of an MI is there is ST elevation in leads V1-V4

Answer 14

Anteroseptal.

Question 15

What is left bundle branch block?

Answer 15

QRS is much broader

Question 16

What test can be done to diagnose an MI but what has to be considered when using this test?

Answer 16

Troponin levels I and T as they are specific to cardiac muscle and C can be found in skeletal muscle.
The test is very sensitive and a diagnosis should not be made solely on a troponin test (“Troponinitis”).

Question 17

What is the mode of early treatment for an STEMI?

Answer 17

Analgesia
Anti-emetic 
Aspirin + clopidogrel/ticagrelor
GTN if high BP
Oxygen if hypoxic
Primary angioplasty
Thrombolysis if angioplasty not available.

Question 18

Why and when is thrombolysis used in MIs and what are the risks?

Answer 18

If the clot still hasnt been destroyed thrombolysis can be administered which clears the artery.
If the patient cannot recieve an angioplasty in 2hrs then thrombolysis is given.
However has a major risk of haemorrhage and failure to re-perfuse.

Question 19

What are complications nof acute MIs?

Answer 19

Death
Arrhythmic complications
-VF
Structual complications
-Cardiac rupture
-Ventricular septal defect
-Mitral valve regurge.
-LV aneuryms
-Inflammation
-Acute pericarditis
Functional complications
-Acute V failure
-Chronic cardiac failure
-Cardiogenic shock.

Question 20

What is the Killip Classification and what is it used for?

Answer 20

It is used to determine in-hospital mortality
I - No signs of heart failure (6%)
II - Crepitations <50% lung fields (17%)
III - Crepitations >50% lung fields (38%)
IV - Cardiogenic shock (81%)

Question 21

What is the most important thing to remember about ECG in acute non ST elevation MI?

Answer 21

The ECG may appear normal.

Question 22

What is troponin testing?

Answer 22

Embolisation
Microvascular circulationa
Myonecrosis

Question 23

What can TnT also be elevated in?

Answer 23

CCF
Renal Failure
PE
Sepsis
Stroke/TIA
Pericarditis/myocarditis
Post arrhythmia

Question 24

What is a class II MI?

Answer 24

When there is an MI that occurs secondary to ischaemia due to inbalance of O2 with demand from coronary spasm, embolism, anemia, hyper/hypotension, arrhythmias.

Question 25

What is MINOCA?

Answer 25

Myocardial Infarction with Non Obstructed Coronary Arteries.

Question 26

ECG of NSTEMI can have T wave depressions. True or False

Answer 26

True.

Question 27

Once a patient has been treated post MI, as a doctor what should you ensure?

Answer 27

That the patient realises their life isn’t going to be majorly hindered.
That they understand their drug therapy and what to expect.

Question 28

What are the 4 pahses of cardiac rehabilitation?

Answer 28

Phase 1- In patient
Phase 2- Early post discharge
Phase 3- structured exercise programme
Phase 4- Longer term maintenance of physical activity and lifestyle change.

Question 29

Who are the cardiac rehabilitation team?

Answer 29

Cardiac rehab nurses
Physiotherapy exercise classes
Smoking cessation specialists
Pharmacists
Cardiologists.